Patients with coronary artery disease often have episodes of silent ischemia during normal daily activities that can be detected by ambulatory ST segment monitoring. We examined the importance of silent ischemia during daily life in patients with coronary artery disease and addressed the question as to whether the presence of these episodes purports increase risk from future cardiac events in this population. In the second study, we examined the importance of abnormal stress tests in this population. The study was conducted in an essentially low risk population of patients with coronary artery disease. It demonstrated that the presence of ischemia during normal daily activities or during stress testing did not result in increased risk in these patients after 4 years follow-up. Increased risk was associated with more severe coronary artery disease. Thus, in the low risk population with coronary artery disease, the presence of ischemia during daily life or during treadmill exercise does not indicate future increased risk from cardiac events.